Provider Demographics
NPI:1811605470
Name:MINDFUL THERAPY & WELLNESS, PLLC
Entity type:Organization
Organization Name:MINDFUL THERAPY & WELLNESS, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:DEVIN
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:BERCAW
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:773-203-5374
Mailing Address - Street 1:5332 W WINDSOR AVE UNIT 2B
Mailing Address - Street 2:C/O DIANE TARCHALA
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60630-3138
Mailing Address - Country:US
Mailing Address - Phone:773-203-5374
Mailing Address - Fax:
Practice Address - Street 1:655 W IRVING PARK RD APT 4817
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60613-3138
Practice Address - Country:US
Practice Address - Phone:773-203-5374
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-11
Last Update Date:2024-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty